Lower Blepharoplasty

Lower Eyelid Surgery

The lower eyelids are a complex structure. They work against gravity and unfortunately, the integral strength of the eyelid reduces as we age which leads to a lack of natural support.

The skin surrounding the eye area is very delicate and naturally, loses its elasticity more rapidly than other areas of the body. As the skin ages, it loses the ability to bounce back to being flat and smooth as we talk, smile and laugh. These day-to-day muscle actions are therefore much more likely to leave permanent lines that manifest themselves as ‘crows feet’.

An upper blepharoplasty or lower blepharoplasty procedure can address loose and sagging skin around the delicate eye area to restore a more youthful appearance.



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  • What is a lower lid blepharoplasty procedure?

    Lower blepharoplasty is a surgical procedure performed to improve the appearance of sagging, loose skin of the undereye area by removing redundant skin without undermining.

    Where required, lower blepharoplasty may be combined with fat redrape to reposition fatty bulges. Because the fat redrape technique involves deeper-level surgery, recovery time is significantly extended.

  • How does the lower eye area change as we age?

    As we age, eyelid skin frequently becomes a concern prompting people to consider treatment to relieve heaviness and alleviate a tired appearance. To understand why these changes develop, we need to have an understanding of the anatomy of the eyelid area and understand the ageing process.

    The prime role of the eyelids is to protect the eye to ensure that the cornea remains hydrated and provides a physical barrier to injury. The brow falls a little as we age, allowing more skin to sit in the upper eyelid. This increases the overhanging skin fold and may give a sensation of heaviness. The quality of the skin also changes, leading to a crepey texture within the eyelid. The increased fold may therefore look cluttered and lose its sharpness, making fat appear more apparent in the corners of the upper eyelid.

    As the delicate skin around the lower eyelid ages, it can often become saggy and loose. This can lead to permanent lines around the eyes known as ‘crows feet.’

    Fat that is naturally present around the eye is kept in place by a structure called the orbital septum. As we age, the orbital septum becomes lax, allowing the fat to prolapse forwards. This gives the characteristic puffiness that commonly occurs with advancing age. With the above changes, the junction between the eyelid and the cheek falls, leading to hollow lines appearing. This gives the illusion of the eye becoming smaller.

    To perform lower eyelid surgery, we therefore need to assess the following:

    • Brow position
    • Skin excess and quality
    • Muscle action
    • Fat prolapse
    • Natural lid tone.
  • Are there multiple techniques involved in lower blepharoplasty?

    The elements that need to be considered with lower lid blepharoplasty are

    The approach to the lower lid is either through a small incision under the lash line or, if there is no skin excess, through the inner aspect of the eyelid (transconjunctival).

    If skin is in excess then it may be removed, often by taking a small strip away just beneath the eyelash line. The amount that can be removed is, to some extent dependent on the tone of the lower eyelid as, in loose lids, excessive removal can lead to lid malposition. Reducing skin is a careful balancing act between skin tightness and lid position.

    If muscle is excessive, a small amount can be trimmed away, but, as muscle contributes to lid structure, this needs to be done carefully. Excess lateral muscle action leading to smile lines may be effectively treated with Botulinum Toxin.

    If fat bulges are present, the fat may be reduced, repositioned, and recontoured. Occasionally fat may need adding to hollows, this is accomplished with fat grafting (otherwise known as a facial fat transfer) either at the time of blepharoplasty or as a separate procedure.

  • How is lower blepharoplasty carried out?

    A detailed consultation with a consultant plastic surgeon is essential prior to undergoing any procedure of this nature. During the consultation, your surgeon will discuss any problem areas, desired improvements, options available (including no treatment at all) and expected outcomes.

    Should a lower blepharoplasty be agreed upon as the most suitable treatment, the procedure will be carried out by your surgeon in our state-of-the-art operating theatre.

    Depending on preference, the surgery may be performed under either a local or a general anaesthetic. The skin is gently cleansed and the eyelid carefully marked, noting areas of fat bulging and skin excess. The incision is usually placed just below the eyelash line to help hide the resultant fine scar in a natural line. The skin is carefully lifted and any fat is recontoured to improve the smoothness of the lower lid. After removing a small strip of excess skin and muscle, the wounds are carefully closed using very fine stitches.

  • After lower lid blepharoplasty, will all the smile lines be cleared and will those bands that appear when I smile go?

    Unfortunately not. The lines are due to muscle action and while lower eyelid surgery can reduce the muscle we cannot remove it all together. If we did, then the lid would be very floppy and droop. A better alternative is to use Botulinum Toxin to selectively relax the muscle fibres and soften the laughter lines safely.

  • I have dark lines under my eyes, will these go after lower lid blepharoplasty surgery?

    It depends on the cause of the darkness. If the darkness is caused by shadows cast by bulging fat then recontouring the fat will help. However, if it is due to the skin being very thin and dark in colour then this will more than likely persist after surgery.

  • My beautician says I have malar bags - will these disappear after lower blepharoplasty?

    Malar bags or festoons are notoriously diffcult to treat and will not improve with standard lower blepharoplasty. They may be improved with a mid facial lift.

  • Is there any downtime?

    After surgery it is essential that you rest and avoid any vigorous exercise or activities that may increase blood pressure and delay healing. Mild swelling and some bruising is to be expected after this surgery, this reaches a maximum after 24-48 hours fading down usually by the 10th postoperative day. Some minor bruising and swelling may persist after three weeks but this may be easily disguised with the careful application of a concealer.

    The fine stitches are removed after one week and specific instructions will be given on massage and muscle exercises.


Lower Eyelid

Anaesthetic Type

Application of local or general anaesthetic at the treatment site ensures total comfort for the duration of the lower blepharoplasty procedure

Procedure Time

120 minutes


The incision is usually placed just below the eyelash line to help hide the resultant fine scar in a natural line. The skin is carefully lifted and any fat recontoured to improve the smoothness of the lower lid


Results can be seen once sutures have been removed and post operative swelling has subsided


Mild swelling and some bruising are to be expected after this surgery, this reaches a maximum after 24-48 hours fading down usually by the 10th postoperative day


Whilst excess skin is permanently removed, lower eyelid surgery doesn’t stop the clock, it merely resets it. As time passes, the ageing process will once again progress.



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